Vitreous rebleed following sutureless vitrectomy: Incidence and risk factors

Abstract

Purpose:This study aims to evaluate the incidence and risk factors for vitreous rebleed (VRB) following 25-gauge sutureless vitrectomy for vitreous hemorrhage (VH) in diabetic retinopathy.Methods:A retrospective review of 190 diabetic patients having undergone vitrectomy for VH at a tertiary eye care center was analyzed. Demographic data of patients along with risk factors such as blood sugar levels (BSL), blood pressure (BP), anticoagulant use, and pan-retinal photocoagulation status (PRP) were tabulated. Depending on the commencement of VRB, patients were divided into immediate rebleed-within 2 weeks and delayed rebleed-beyond 2–4 weeks.Results:Forty-one patients had VRB, out of which 18 patients had immediate VRB and 23 patients had delayed VRB. The average duration between vitrectomy and VRB was 3.28 months. Twenty-eight patients were male and 13 were females. Average age at presentation was 53.8 years. Thirty-four patients (82.9%) were found to have high BSL and 28 patients (68.3%) had high BP and they developed rebleed (P < 0.01) after an initial hemorrhage-free period (average = 5.15 months). Fifteen patients (36.6%) underwent first time PRP intraoperatively, and they had immediate rebleed (P < 0.01) without any hemorrhage-free period (average = 0.9 months). Eight patients (19.5%) were on perioperative anticoagulants; however, their statistical significance did not persist in the multivariable model. There were neither age nor gender predilection toward rebleed (P > 0.05).Conclusion:The incidence rate of VRB was found to be 21.6%. Age and gender did not contribute to rebleed. Intraoperative PRP was a risk factor for immediate rebleed. Poor glycemic and BP control was a risk factor for delayed rebleed.

Multiple factors in the prediction of risk of recurrent vitreous haemorrhage after sutureless vitrectomy for non-clearing vitreous haemorrhage in patients with diabetic retinopathy

“…The Cr values won`t be increased, unless the degree of kidney damage accounts for more than half of the kidney. As has previously been found, silicone oil and inert gases such as SF6 and C3F8 may decrease the incidence of postoperative RVH, especially in early RVH cases [22]. One possible reason for this may be that longstanding mechanical tamponade of fragile retinal vessels by oil or gas bubbles that occurs with this procedure.…”

Multiple factors in the prediction of risk of recurrent vitreous haemorrhage after sutureless vitrectomy for non-clearing vitreous haemorrhage in patients with diabetic retinopathy

“…As has previously been found, silicone oil and inert gases such as SF6 and C3F8 may decrease the incidence of postoperative RVH, especially in early RVH cases [24]. One possible reason for this may be that longstanding mechanical tamponade of fragile retinal vessels by oil or gas bubbles that occurs with this procedure.…”

Intravitreal ranibizumab injection at the end of vitrectomy for diabetic vitreous hemorrhage (Observational Study)

“…[15,18–20] Although the exact source is unclear, early recurrent VH may be caused by the dissolution of blood clots trapped in the remaining antero-peripheral vitreous gel, remnants of fibrovascular tissue, or reactivation of retinal sites that bled intraoperatively. [21–23]…”